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Cutaneous Larva Migrans
Cutaneous larva migrans (CLM, also creeping eruption) is the skin manifestation of hookworm infestation.
CLM is caused by Ancylostoma sp, most commonly dog or cat hookworm Ancylostoma braziliense. Hookworm ova in dog or cat feces develop into infective larvae when left in warm moist ground or sand; transmission occurs when skin directly contacts contaminated soil or sand and larvae penetrate unprotected skin, usually of the feet, legs, buttocks, or back. CLM occurs worldwide but most commonly in tropical environments.
CLM causes intense pruritus; signs are erythema and papules at the site of entry, followed by a winding, threadlike subcutaneous trail of reddish-brown inflammation. Patients may also develop papules and vesicles resembling folliculitis (see Folliculitis), called hookworm folliculitis. Diagnosis is by history and clinical appearance.
Although the infection resolves spontaneously after a few weeks, discomfort and the risk of secondary bacterial infection warrant treatment. Topical thiabendazole 15% liquid or cream (compounded) bid to tid for 5 days is extremely effective. Oral thiabendazole is not well tolerated and not usually used. Albendazole (400 mg po once/day for 3 to 7 days) and ivermectin (200 mcg/kg once/day for 1 to 2 days) can cure the infestation and are well tolerated.
CLM may be complicated by a self-limiting pulmonary reaction called Löffler syndrome (patchy pulmonary infiltrates and peripheral blood eosinophilia).
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